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PERMIT APPLICATION <br /> BUILDING-I CHANICAL/ PLUMBING /SIGN /ANKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)ever: eitr . I www.everettwa.govlpermits <br /> (Blue or Black Ink Onily"Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: tok - #fes <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Plellsttbdi`vi5inn <br /> Condo. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: lapik iti, ' TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: STREET , a <br /> .: __ ZIP •; <br /> OWNER PHONE: <br /> . - OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS;. STREET <br /> ____ CfTI' STATE l A - 0-'"C.-i,,.,� <br /> Ct' NTRACTSit;PHONE: ZIP <br /> t1 r�� (CONTRACTOR EMAIL: <br /> coNTRAcroxLICENSE�f IJIRER) , r <br /> ;tZ,wI CITY OF EVERETT BUSINESS LICENSEiIt{REdGtYtTtFtEf3j0 <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> tOt4`TACTNAME: <br /> CONTACT PHONE- .,, <br /> CONTACT EMAIL: . ' <br /> BUILDING PERMIT,APPLICATION <br /> Existing Use of Buildin <br /> .., Contract Price of Work _ <br /> Proposed'Use of Building: meat Source: 5t a ❑Electric ❑Other <br /> Building Type: .FR.'Detached ❑SFR-Attached ❑Duplex <br /> 0Multi-FamiiY1of Units:. ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Rep tlr; DTA, ( Sign C Sprks [er ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> • . t I GPP VcS 4_ g,(4,y1 10 -ey‘ischrK s <br /> ASSOCIATED BUILDING PERMIT#:.if a.i <br /> ieable.i <br /> MEC :FOCAL PE-MIT APPLICATION <br /> PLUMBING PERMIT APPLICATION <br /> Type of Project: _New , Addn _Alteration Repair Type of Project: _New Addn Alteration _Repair -. <br /> #of <br /> List of Fixtures i1 of <br /> Fixtures Fixtures List of Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC—Air Handling Units ,.,Heat Pump Toilet <br /> Forced Air Systems .._ ^Unit Heater Urinalow•Preventer,((Inside Bldg) <br /> Gas Piping Boiler <br /> � _ . BaEEthtub Urin,xli <br /> t vatery;(;Wash min) Drinking FOR tri <br /> .Water Heater Refrigeration 'Shuler <br /> I Gas Fireplace `" Wood Stove Greaseree drTia <br /> Gas Range Kitchen Sink�Dit�ttel Trap <br /> S Ducting D shwa Stier Roof Drains <br /> Clothes:Dryer Hopi Other , " Clothes Washer Medical Gas <br /> Range Hood <br /> Water Heatert :. <br /> Exhaust Fan <br /> Sink(Set ricel arlMo +ete ". Other <br /> SPRINK-R/SO P" E$$$061 SYSTEM e <br /> If urnber of Heeds <br /> a CKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> :urrent federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> 3uilding Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> mrd I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 4 <br /> l 10 kt 2 -0 <br /> n tflfiuthortited Agent Signature ` <br /> ti�ui52�t6J 4 <br />